The Origins of Advance Decisions
Advance decisions are very often compared to living wills and the principle of will making has been used for people faced with at temporary illness or an irreversible condition such as dementia who wish to make treatment and/or care decisions before they are unable to make those decisions as a result of mental incapacity.
In 1989 Survivors Speak Out (a user group of mental health services in London) initiated the crisis cards scheme to allow service users to say what treatment they did want and did not want in a time of crisis. This can be seen as the forerunner of the Advance Decision/statement for people who had experienced mental health difficulties at some point in their lives.
Case law in the 1990's confirmed the legally binding nature of advance treatment refusals under common law. Since then a number of voluntary organisations such as the Alzheimer's Society and Age Concern have been assisting people with the crisis decision-making by giving information and help with the drafting of advance statements or advance directives.
Now the government has introduced a law that will give a legal right to draw up Advance Decisions to refuse specific treatment. You can also make an advance statement of any treatment preferences you may have. These proposals are outlined in the Mental Capacity Act 2005, which will come into effect in April 2007.
Advance decisions are instructions to health care staff who may be involved in your future treatment, if you lack capacity at that time.
What an Advance Decision cannot do:
- It does not authorise inappropriate treatment or euthanasia
- It does not authorise the refusal of basic care
- The Mental Health Act overrides the right to refuse treatment for a mental disorder as specified under the 1983 Act
What an Advance Decision can do:
- It lessens the risk of receiving unwanted treatment
- It offers you the opportunity to inform carers and mental health professionals about your wishes and plans to refuse certain medical procedures or treatment in advance - at a time when you are not able to make that decision
- It improves communication between all individuals involved in your care and treatment
- It enables you to make an informed choice about what is happening in your life, which promotes empowerment